COVID-19 and the impact of arterial hypertension-An analysis of the international HOPE COVID-19 Registry (Italy-Spain-Germany)

Abstract

Background: A systematic analysis of concomitant arterial hypertension in COVID-19 patients and the impact of angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs) have not been studied in a large multicentre cohort yet. We conducted a subanalysis from the international HOPE Registry (https://hopeprojectmd.com, NCT04334291) comparing COVID-19 in presence and absence of arterial hypertension.

Materials and methods: Out of 5837 COVID-19 patients, 2850 (48.8%) patients had the diagnosis arterial hypertension. 1978/2813 (70.3%) patients were already treated with ACEI or ARBs. The clinical outcome of the present subanalysis included all-cause mortality over 40 days of follow-up.

Results: Patients with arterial hypertension suffered significantly more from different complications including respiratory insufficiency (60.8% vs 39.5%), heart failure (9.9% vs 3.1%), acute kidney injury (25.3% vs 7.3%), pneumonia (90.6% vs 86%), sepsis (14.7% vs 7.5%), and bleeding events (3.6% vs 1.6%). The mortality rate was 29.6% in patients with concomitant arterial hypertension and 11.3% without arterial hypertension (P < .001). Invasive and non-invasive respiratory supports were significantly more required in presence of arterial hypertension as compared without it. In the multivariate cox regression analysis, while age≥65, benzodiazepine, antidepressant at admission, elevated LDH or creatinine, respiratory insufficiency and sepsis might be a positive independent predictors of mortality, antiviral drugs, interferon treatment, ACEI or ARBs at discharge or oral anticoagulation at discharge might be an independent negative predictor of the mortality.

Conclusions: The mortality rate and in-hospital complications might be increased in COVID-19 patients with a concomitant history of arterial hypertension. The history of ACEI or ARBs treatments does not seem to impact the outcome of these patients.

Keywords: COVID; hypertension.

FIGURE 1

Kaplan‐Meier curve of survival over 40 days of follow‐up in presence and absence of arterial hypertension

FIGURE 2

Kaplan‐Meier curve of survival in patients with arterial hypertension and concomitant treatment with ACEI or ARBs as compared to arterial hypertension without ACEI or ARB treatment

FIGURE 3

The outcome and in‐hospital course of patients with continued treatment of ACEI ond ARBs vs stopped treatment is presented. Different complications including respiratory insufficiency (RI), heart failure (HF), acute kidney injury (AKI), upper respiratory tract infection (URTI), pneumonia, sepsis, O₂ requirement at admission, invasive respiratory support (MV) or use of high‐flow nasal cannula (HFNC) are compared (*P < .05, **P < .001)